Healthcare Provider Details

I. General information

NPI: 1164541900
Provider Name (Legal Business Name): INTERNAL MEDICINE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 NE 12TH STREET
GUYMON OK
73942
US

IV. Provider business mailing address

PO BOX 158 410 NE 12TH STREET
GUYMON OK
73942-0158
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-5500
  • Fax: 580-468-4942
Mailing address:
  • Phone: 580-338-5500
  • Fax: 580-468-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18750
License Number StateOK

VIII. Authorized Official

Name: DR. JEFFREY J LIM
Title or Position: MEMBER
Credential: MD
Phone: 580-338-5500